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More on Treadmill Stress Tests...

Posted Jul 31 2008 6:16am 1 Comment
Last monthNBC’sTim Russert suffered a fatal heart attackat age 58, shocking the country. He recently passed a stress test, so how could this happen? In a post Dr. Fuhrman explains whystress tests fail to determine heart attack risk. Here’s an excerpt:

A stress test is not an accurate test for determining the risk of a heart attack. A stress test only identifies obstructions, it doesn't identify vulnerable plaque—the plaque that is likely to throw a clot. A stress test can only detect a blockage of more than 80% and the propensity of plaque to rupture has nothing to do with the amount of obstruction…



…Stress tests are big money-makers for doctors. They identify those people with large blockages who qualify as candidates for costly angioplasty or bypass surgery. However, drugs and medical procedures reduce risk only slightly.

Now, Jane E. Brody ofThe New York Timestalks toDr. Todd D. Miller, a cardiologist and co-director of theMayo Clinic’s Nuclear Cardiology Laboratoryin Rochester, Minn., aboutthe shortcomings of stress tests. Take a look:

Mr. Russert’s treadmill test may have put him in the low-risk category, Dr. Miller said, “but that doesn’t mean no risk.”

“Maybe 3 patients in 1,000 with a low-risk test will die from heart disease within a year,” he said. “Among those deemed at high risk, more than 3 patients in 100 would die within a year.”

Furthermore, when the stress test is used for people who are at low risk for heart disease, an abnormal finding is most often a false positive that prompts further testing that is far more costly, Dr. Miller said.

The stress test’s main advantages are its rapidity and low cost — one-fifth to one-quarter the cost of more definitive and often more time-consuming tests like a nuclear stress test, CT coronary angiogram or standard angiogram. Medicare pays about $150 for a standard stress test, though hospitals typically charge three to four times that when the test is done on younger patients.

Criticism for stress tests is not new. In 2007,Karen Dente, M.D., a medical journalist based in Brooklyn, New York, stated that asstress-testing and coronary angiograms may no longer be the true gold standardfor detecting coronary stenosis. ViaMedscape:

"Conventional stress-testing and angiogram gives you no information on whether a plaque is going to rupture,"David DuBois, MD, an attendee at the symposium and emergency medicine specialist from Pinehurst, North Carolina, told Medscape. "[With these tests] there are a lot of false-positives and false-negatives," he said.



One of the hottest current discussions in the evaluation of acute coronary syndromes is centered around the use of computed tomography coronary angiography. "CT technology is advancing at a very fast rate," saidAmal Mattu, MD, associate professor and program director of emergency medicine residency at theUniversity of Maryland, explaining the technology's improved detection in plaque composition and remodeling compared with conventional diagnostic tests.

"If you have a radiologist that can give you an accurate reading with the new 64-head multidetector CT scans, you can detect occlusions better," according to Dr. Dubois. But we are still a long way from having the new technology replace standard coronary angiography for the detection of large coronary stenoses, he said. "It is not going to change the [current] practice any time soon."

Sadly, this information can’t helpTim Russert, but doctors and patients should now take note that traditional testing procedures might be lulling us into a false sense of security by not revealing crucial life-saving data.

Comments (1)
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In 1992 at age 47 and physically fit, I had a MCI. Between the years or 1992/1996 I underwent 6 angioplasties, than finally double bypass surgery. Since my 1996 successful surgery, a thallium stress test performed five years later showed one of the bypass grafts 100% closed. I have had anxiety, panic attacks, and depression for years after my discharge from Vietnam in 1968. I've been diagnosed with PTSD and take 200 mgs of Sertraline daily for the past 16 years. I also have hypertension but never really high numbers. The Dept. of Veterans Affairs continues to state I have onlt a 10% cardiac disability aggravated by my PTSD because I have been able to attain10 Mets on a treadmill stress test. I told them take one can die of a MCI soon after a treadmill stress test and that it can not see the amount of plague buildup within the arteries, yett I can't convince them. I take aspirin, atenolol, and atorvastin for my heart. I still experience angina during stress which I take sub-nitos for. There is no history of heart disease in my family. In the past year and a half, I've been diagnosed with diabetes type II, had my right cancerous kidney removed and my right adrenal gland, and part of my colon and 8 inches of my intestines removed due to an attack of diverticulitis. They say they got all the kidney cancer but I worry since I once beat thyroid cancer (pappillary carcinoma) in 1993, had my gall bladder removed in 1998, and feel that the odds are catching up to me. I must have had at least 8 angiograms in my lifetime and worry that I may die just to prove that my CAD is life threatening to the DVA. With now having diabetes, and undergone these many surgeries in a short period of time, would it be wise to go for another angiogram? May I have your professional feedback regarding some of the problems I am having trying to address my medical issues like, the accuracy of treadmill stress tests, the effect stress has on heart disease, and my ordering an additional angiogram. thank you so much for listening.  Sincerely, Edward Sparacio
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